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Kidney Week

Abstract: PO0276

Prevalence of Severe Anemia and Transfusion Risk in Medicare and Non-Medicare Populations with CKD Stages 3 and 4

Session Information

Category: Anemia and Iron Metabolism

  • 200 Anemia and Iron Metabolism


  • Davis, Jill, AstraZeneca, Wilmington, Delaware, United States
  • Perkins, Robert M., AstraZeneca, Wilmington, Delaware, United States
  • Petrilla, Allison A., Avalere Health, Washington, District of Columbia, United States
  • Robinson, Scott B., Avalere Health, Washington, District of Columbia, United States
  • Powell, Dakota C., Avalere Health, Washington, District of Columbia, United States
  • Murunga, Anne, Avalere Health, Washington, District of Columbia, United States
  • Kumar, Shambhavi, Avalere Health, Washington, District of Columbia, United States
  • Dietz, Kevin, Avalere Health, Washington, District of Columbia, United States

While 30 million people in the United States have chronic kidney disease (CKD), the real-world clinical burden of anemia in non-dialysis dependent (NDD) CKD patients is poorly documented, which we seek to address.


A retrospective cohort analysis was conducted using the 100% sample of Medicare Fee-For-Service (FFS) beneficiaries (parts A/B/D) and a convenience sample of Commercial (Com), Medicare Advantage (MA), and Managed Medicaid (MM) lives from Inovalon’s Medical Outcomes Research for Effectiveness and Economics (MORE2) Registry® linked to eGFR and hemoglobin (Hgb) values from Prognos laboratory data. Patients with ≥2 consecutive eGFR tests with eGFR 15-59 mL/min/1.73m2 (≥90 days apart) between 1/1/2016 to 12/31/2018 were retained for analysis; patients on maintenance dialysis were excluded. Severe anemia was defined as Hgb<10 g/dL, measured within 90 days of index eGFR. Red blood cell transfusion (RBCT) during a 12-month follow up was identified using procedure codes. A logistic regression model identified baseline factors associated with receiving RBCT.


A total of 1,305,354 patients were identified from Medicare FFS and 154,163 from MORE2. Prevalence of severe anemia in the Medicare FFS cohort was 3.1% and 3.3% in the MORE2 cohort (Table 1). Severe anemia was highest among stage 4 CKD patients at 11.3% in the FFS cohort and 13.4% in MORE2 cohort, with prevalence among MM patients at 17.1%. Hgb value, cancer, diabetes, liver disease, and hospitalizations were risk factors for RBCT. Within the MORE2 cohort, the odds of receiving RBCT increased by 47% for each 1 g/dL decrease in hemoglobin.


The proportion of severe anemia increases with worsening CKD stage in NDD patients primarily enrolled in Medicare FFS. Many clinical factors influence the odds of severely anemic NDD CKD patients receiving RBCT.

Prevalence of Severe Anemia by Payer and CKD Stage
 Medicare FFS CohortTotal MORE2 CohortCommercialMedicare AdvantageManaged Medicaid
Patients, N1,305,354154,16335,69783,70734,759
Prevalence of Severe Anemia, N (% of total)40,783 (3.1)5,033 (3.3)930 (2.6)2,421 (2.9)1,682 (4.8)
Severe Anemia by Stage, N (% within payer and stage)     
3a15,830 (1.8)2,361 (2.1)419 (1.5)1171 (1.9)771 (3.1)
3b14,069 (4.1)1,501 (4.7)272 (4.6)739 (4.0)490 (6.5)
410,884 (11.3)1,171 (13.4)239 (13.5)511 (11.3)421 (17.1)


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